Confused about what to expect in midlife? Wondering how to treat mysterious symptoms like night sweats or stubborn weight gain? I got you. Welcome to my channel, where I give you straight tea on everything from painful sex to heart health through my weekly videos. I’m Dr. Heather Hirsch, a board-certified internist, accredited menopause specialist, founder of the menopause clinic at Brigham and Women’s Hospital, and former faculty at Harvard Medical School. I see women in my private telemedicine practice (in 8 states, CA, NY, MA, NH, RI, FL, OH, and AK), so head toheatherhirschmd.com/bookings to schedule!
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I take estradiol 1mg and progesterone promitrium and I still have bad sleep and anxiety! How can I get the cream ? Any information please thanks.
how do I use you as my menopause dr. in alaska please ?
United States and the majority of us 5:12 do favor and tend to choose micronized 5:15 natural progesterone prometrium or the 5:17 bioidentical progesterone over the 5:20 synthetic progesterone
I was only prescribed 100 mg prometrium nightly. No problems.
Can I apply this cream in my vulva and not inside ?
Hi, I’m from Europe and the knowledge on progesteron intolerance is not so good unfortunately 😢 I tried bio-identical progesteron in different doses & different ways (oral, vaginally), but I really couldnt handle the depression (200 mg) or the extreme bleedings (100 mg). I also tried Duphaston and Primolut, but I get really depressed from it. I also suffered from PMS after my pregnancies and it feels like that, but even more extreme. Now I will try Mirena and hopefully that works for me. I know that also Mirena can cause problems for some women, I just hope I’m not one of them. Alsobtaking oestrogel 3 pumps a day, which really helps me. It’s the progesteron that is not working for me 😢
Taking oral microniozed progesterone, 100mg for 5 weeks and instead of helping me sleep, it has the opposite efect. My sleep is worse! When i take a day off the pill, i sleep so much better! Any suggestions? Should i take it every other day? Will it provide the same uterine benefots? (Note- i also take 0.05mg estradiol patch 2x per week and 4mg testosterone cream daily)
I had the same problem trying to take it orally, I felt awful and sleep was terrible. I take it vaginally and rectally, and it does seem to help me with sleep, maybe because the blood levels are higher, I don't know. Our bodies are so different
The mirena an iud was a nightmare for me. So was the maxim, visanne and the mini pill ( a progesterone only) daily pills. I had to take them to control my endometriosis but the medicine was so much worse than the problem. I’m not perimenopausal yet, but it gives me hope to know I have other options for when I will need them!
Do here is the crazy thing. For the last 3-4 years I’ve suffered from dry eyes and mouth. No clue why, I don’t wear contacts etc. been taking HRT for two weeks and my eyes are not dry and note is my mouth. It’s so strange.
I’m sure ur not talking about post menopausal women on progesterone bc that is just not true. You should always specify specifically who ur talking to. Regular women, pre menopausal, & post menopausal women. That makes a huge difference. Ty.
Very helpful. Thanks ❤
I have endometriosis and diagnosis of PMDD. While pregnant prometrium for first three months was great. Now in peri and have Mirena which causes major mood problems and it seems my endo lesion under my right ribs is getting worse. I am on Estradiol and wondering if I should also take low dose prometrium for Endo lesions outside the uterus, since I have more pain now and since everyone says the Mirena is not systemic. Please advise. My obgyn doesn't seem to know
I’ve had issues with so many progesterones from constipation to bleeding. Last one was the 100mg and caused severe allergic reaction of swollen and itchy hands and feet. I got tested for peanut, soy and gelatin allergies and nothing. So now I have a very small estrogen patch and we’re going to try vaginal ultrasounds every so often or a potential synthetic progesterone every three months for a few days to see if that can work. But the estrogen patch is so helpful for my hot flashes and sleep so I’d hate to lose it due to progesterone problems. I’m nearing menopause and in late peri going now 4 months without a period fyi.
Do I really need to be post menopausal? I'm in peri. I already have a Mirena IUD, and asked for estradiol patches to go with it to smooth the perimenopause ride. The NP prescribing said I could keep using this combo as long as my body allows the IUD to be replaced on schedule.
i was fine with 100mg progesterone orally but at 200 mg, i had painful abdominal bloating, inability to pass gas, constipation and diarrhea. switching to vaginal delivery resolved the symptoms.
So I can use the norethindrine pill I take orally, vaginally?? I have severe side effects usually for a day or 2 but just live through them. I take it the 1-12 monthly.
I think it's just the micronized progesterone capsules that you can use vaginally
What about inserting it rectally? Vaginally gave me a yeast infection.
They have done studies on this that you can find online, blood levels from vaginal and rectal are very similar and can be double the oral dose because it does not get processed through the digestive tract. Other menopause specialists like Dr Louise Newsom in England talk about this in terms of vaginal administration. Vaginal administration also has the benefit of uterine first pass effect, so even though the blood level will be similar to rectal and greater than oral, the endometrial progesterone levels are much higher because it gets absorbed right through the cervix. I have done it rectally and I definitely feel the same whole body effects as I do from vaginal administration. Also, if I'm taking it vaginally and I start to feel a little off in terms of my vaginal flora, I switch back to rectal, and a boric acid vaginal suppository takes care of it before it becomes anything full blown. I was grateful to my gynecologist for that tip, it's nice to be able to easily and immediately self-treat and not have to constantly take antibiotics. But, it has worked for me because I don't wait until I have something full-blown, and even if I don't have anything going on, my gynecologist was fine with me using one suppository a week just to keep everything balanced. I also notice that it has a cleaning out effect, any of the undissolved capsules or remnants of the creams and capsules come out with the boric acid. But unlike douches and soaps, it supports the acid environment of your vagina and therefore the flora benefits. I also use vaginal estrogen cream several times a week
Just started estradiol and 100mg of progesterone about 2-3 weeks ago. I feel wonderful!!! However, within 48 hours my tinnitus went from mild and intermittent to severe and constant. I have messaged my gynecologist and I’m waiting for her answer. Sleeping like a baby for the first time in years and less urinating, but the tinnitus is definitely aggravated by one of those hormones.
I started with a couple cycles of estrogen only which had only positive effects. Once I introduced prometrium my tinnitus revved up in a very obvious way. Dizziness, slowed gut, sore breasts , achy joints, and low energy too. Kind of makes sense, since these are the symptoms I've always had the week leading up to my cycle. It does help some people sleep. I've talked to women who have the same effects using the mirena IUD, so there doesn't seem to be a silver bullet for everyone, just have to talk to a specialist and trial different stuff until the positives outweigh the negatives. I'm happy for those who have positive effects from progesterone
I chose to not replace my patch. It’s been 24 hours and I don’t notice my tinnitus lessening. I’ll see what happens when I quit the prometrium. I hate that there always has to be a compromise, but I guess that’s life. Thanks for your comment.
Yeah, so sorry, it is a bummer when there isn't just a straightforward answer. We are all so different in how we respond to hormones. I also have endometriosis, so then there's this whole other layer. But don't lose heart, and if you can swing it do try to talk to a menopause specialist and try a few different things before you give up. Going from oral to vaginal improved some symptoms for me. Taking it at a lower dose continuously versus sequential solved some issues. You might get to the point where you can deal with the side effects because overall you're better than before you started 🤞 I'm hoping we eventually have more options. I just know in terms of overall health going forward, I'm convinced that HRT is the best route for me
I had severe side affects from it so went very slow....one 100mg every 3rd day for a while then every 2nd day for a while and gradually my body got used to it every night.
I am super sensitive when it comes to dosages …. Is it really necessary to take a synthetic progesterone ? Are there any homeopathic remedies?
I tried Compounded progesterone 50mg pills and had horrible mood swings and anxiety, especially when e levels are low
On Prometrium causes Bloating and acne for me , still sticking with it though .
Same but I also had all the other side effects. I switched to norethindrone.
Is constipation a side effect of progesterone?
For me I get constipation if I use it rectally but not if orally
If you look it up online you'll see that progesterone is known to slow gut motility, so yes it can worsen constipation. Super important to have a high fiber diet, drink water, exercise. I found that I also had to start adding daily psyllium and ginger, with intermittent magnesium supplements just to get back to my baseline. Never had issues before starting prometrium
Thank you for taking the discussion on progesterone intolerance a bit further than I’ve seen before. I’m 59 and have tried Prometrium, Mirena, Tibolone, Norethisterone and currently 10 days in to trying Slinda. I’m now getting a painful bleed on Slinda. I feel like I’m being difficult and I just want to get off the roundabout and not see a doctor ever again. I will persevere for a few more weeks with Slinda as Ihave no other adverse effects from it. I’m tired of pain (have had a clear Propel biopsy). I’d happily agree to have the useless uterus and it’s friends removed so that I can get on with living my life😂
@@alisonmacfarlane9895 look up Carol Petersen. She discusses that p intolerance could be from under dosing. She increases the dose until those symptoms go away. If that doesn’t work she looks at yeast overgrowth and blood glucose levels.
I’m on 100mg of progesterone for sleep (which has stopped working) and I’ve noticed constipation. I have ulcerative colitis so I may need to come off it and I’ll discuss with my NP next week.
I cannot take more than 100mg. Not sure if it is having any positive effects, but more than 100mg gives me severe breast tenderness.
The equine progesterones are cruelly derived. They are from horses that are medically enslaved into a cycle of pregnancy and catheterized. They are terrible and if you take these you are contributing to a life of horror to our fellow creatures. There is ZERO reason to still be deriving hormones this way. The US is out of step with the rest of the world here. Only pharmaceutical companies want to keep this going. It was well studied because it was the only option at the time of the studies. That is NOT the same as being the best option. I BEG you all to think for yourselves and go with YOUR values, not blindly follow.
So for taking the progesterone vaginally, does that mean that you simply place the pill that you are prescribed to take orally and insert it vaginally? And if you take it vaginally, is it every day or every other day? I am on 100 mg of progesterone
Yes, the capsule will dissolve. Best to do it at night while you're lying down and get it as far back in the vagina as possible so it can be absorbed through the cervix. Different menopause specialists have differing views on dose, most in the US want you to take the same daily dose as you would with an oral regimen, some in the UK are okay with every other night because research has shown that vaginal absorption can be more than double oral, and there is a vaginal first pass effect where the endometrium absorbs a much greater amount via the cervix.
@@athenachloewoodrow6356 wow, thanks!!!
Im 52, 16 months after my last period, my perimenopause was about 6 years , mostly insomnia, terrible migraines ( passed out and injured head on a sidewalk after 9 days of migraines) , gained 10 lbs, havents slept more than average of 5 hrs per night for the last 6 years . Im on prometrium, and estradiol patch . its been 8 days , i slept like a baby and dreamt vivid dreams . So far i love it , minor nausea and slight cramping . A lil bloating . 200 mg every night . My question, if i stop after 12 days, will I bleed? So far i think i love it !
Yes you will
I only take it 12 days per month and I do not bleed when I stop. I’m 51 and this is my 4th month taking progesterone. Last cycle was March 2024.
Yes!! I had severe muscleskeletal aches and pains. I brought up premenopause as a potential cause to each doctor I was referred to. Crickets! Finally after being ran through the circuit of doctors.....my Ob-Gyn finally agreed to try HRT.
Taking progesterone vaginally every other night was a game changer. I am post menopausal and am on a relatively low dose of estrogen patch.
Please share dosage and type of progesterone and method vaginally?
100 mg of progesterone at night. I’m using estradiol patch and estradiol vaginal cream. Had a DNC due to bleeding. What a journey. I’m 69 years old.
I’m doing nearly this exact regimen at 51 and it has been so helpful. I only take the progesterone for 12 days per month.
200 mg of Progesterone and it’s so great! Only positive for me. Take at bedtime. Generic prometrium
wonderful!
I am so jealous 😊but Glad for you .
Hello Doc, I was diagnosed with POI 3months ago.. Would you recommend Birth Control or HRT? If you want to get pregnant
Thank you for this video, I always appreciate the education. I'm going to push back a little bit on your assertion that the progestin IUD does not go systemic. That is simply not the truth. Yes the majority of it goes to the uterus, and yes blood levels are significantly lower than being on the traditional birth control pill. But, it absolutely goes systemic, it affects all the other tissues in your body including your brain and breasts. That doesn't mean that the effects are terrible, but I see just as many women reporting the same side effects with this IUD as those taking micronized progesterone. Everyone is different, many women do really well with the IUD, but many do not. I have been to several menopause specialists, I have been on HRT for a couple of years, and have tried some different options. The first menopause specialist urged me to go on continuous birth control pills, but I have to be honest that they did not inform me fully of all the possible side effects. I ended up with personality changes and zero libido. When I reported these changes, the response was " Yes sometimes that happens"; however, that was never communicated to me as a possibility . I switched to HRT, and have not yet found a way to mitigate the progesterone sensitivity fully, but as of now the positives outweigh the negatives. So, I guess what I'm saying is that I really think it's incredibly important to include all information so that patients can have true informed consent. I get that menopause specialists are wanting to be super supportive and be cheerleaders for women in midlife, and I so appreciate that, but I find that they have their own form of gaslighting at times when they lean too much towards the positive spin and don't give 100% straightforward pros and cons. There are studies easily obtained online that look at the difference in blood serum levels of progestins comparing hormonal iuds with birth control pills. The blood levels are still significant, and those women having negative side effects from hormonal iuds need some acknowledgment of that.
Mirena is know in France to increase the risk of meningiome.
I do have huge side effects of progesterone. I take now dydrogestérone (I'm not sure it is available in US). I have to cut the (small) tablet in 8 and take it only twice a week. If I take more or more often, my bowel movement stops. Even twice a week, I have to take a laxative the day after because of the slowing effect. I also have to drink a strong coffee not to be sleepy all day long. I had to stopped my oestrogens cream for one month because of this very poor tolerance of progesterone. I feel stuck.
She speaks of alternatives in this video. Also Carol Petersen suggests increasing progesterone (increasing until symptoms subside) for those who have intolerance.
I couldn’t take 200 mg of progesterone at bedtime. I would wake up feeling tired, nauseous and dizzy. I started taking 100 mg at night and 100 mg in the morning. This fixed my problem.
What is your take on side effects from Prometrium caused by filler ingredients like titanium dioxide USP, D&C Yellow No. 10, FD&C Red No. 40? Would you go to compounding route with cleaner ingredients when you really want to stay with human bioidentical micronized Progesterone for obvious reasons and at the same time want to avoid side effects of toxic fillers and peanut oil?
I am perimenopausal and experience severe depression on days 14 to 28 of my cycle after taking prometrium
Me too, along with extreme moodiness and irritation, anxiety.
Me too ! Im on combined pill and wondering what ti do next
Interesting - could be the progesterone - try going without out it for 1 -2 cycles and see if that goes away (tell your doctor and this is okay to do)
I have Progesterone intolerance and the worst. This month I tried Norathindron. I was supposed to take for 10 days. After 6 days I felt so bad, I had to stop. What about Progesterone Cream? 🙏
Progesterone cream is NOT safe because it does not readily absorb though the skin. It's also why its better tolerated (you are not really getting anything)
If you had progesterone intolerance, what alternative worked for you? Tell me in the comments along with any other questions
Thank you! I am so sick of being told progesterone intolerance is rare or all in my head. I wanted to love prometrium but it gave me every single side effect. I ran back to my 0.35 mg norethindrone mini pill which gives me no side effects at all. I’ve been on it for years and recently had a uterine scan. Thin lining. It works! PS I think I would be dead without my estradiol. I took oral for years. New doctor is insisting on patch and balking at raising the dose. She wants me off because I’m 65. UGH
No, you don't have to take oestrogen along with progesterone IF you have endometrial cancer and the treatment is just progesterone...
Anxiety leading to a lack of confidence and jealousy… I’ve never been jealous or insecure and then all of the sudden… boom… it’s been a few weeks of calming myself down but I NEVER want to feel that again… it’s tapered off but I feel it there… I’m actually SCARED it’s going to come back… I guess that’s the anxiety… and dread, hopelessness and regret… what?! I have an appointment next week to go over possibly starting HRT… if my dr doesn’t listen I’m paying to see one of Dr Hirsch’s NPs
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Yes, but what about women in the advanced stages of perimenopause who still struggle with insomnia, despite using bioidentical progesterone and a small amount of testosterone gel? Despite adhering to all recommended practices, nothing seems to alleviate the problem. This critical issue is not receiving the attention it deserves in current discussions.
I’m so appreciative of people finally talking about this subject. I was told what to expect entering puberty. Where are the crappy health class videos when you turn 35 so you know what’s going to happen? Every symptom that comes up I tell the doctor and I get “oh yeah that’s part of it”. Everyone knows about hot flashes. No one talks about hair loss and changes to your hair texture, joint pain, itchy skin, rage, body weight redistribution, etc.
Ant crawling on the back
My GYN says you don't need labs...if you are having symptoms: night sweats, hot flashes, mood fluctuations, brain fog, insomnia, heavy bleeding, feelings of rage...you are in perimenopause
The best definition I heard is that Menopause is just 1 day in your life. It’s the documented day where you have not had a period for 12 months. All the time leading up to that is perimenopause. After that day is post menopause.
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